So it's not surprising that writers and bloggers are discussing our rising rates of obesity, and possible ways to counteract that. Matthew Yglesias writes:
But there's a very profound problem of evolutionary psychology here. For the vast majority of human existence people were engaged in much more daily physical activity than is the typical member of a contemporary rich society and it was impossible to be certain that food would be available in the future. Consequently, people are largely designed with the instinct to err on the side of eating more food rather than less. Especially if the food is tasty. These days, of course, we're in a very different situation. Nobody starves to death in the contemporary United States, but lots of people have problems related to poor dietary habits.
Hardly an original point on my part. But the sign made me think of
it. And I suppose I would make the point that at the margin
expenditures of funds to fight this tendency are going to do a lot more
to improve public health than will expenditures of funds to treat
people's diabetes.
That presumes you can find a marginal dollar that will reduce peoples' tendency to eat more than they burn just as effectively as we treat diabetes. Seven years ago, when I investigated fast food lawsuits, I found very little evidence for that proposition. Pretty much every public health effort to get people to eat less has proven a dismal failure. As Paul Campos has noted, telling people to eat less and exercise more is the most exhausitvely attempted experiment in the history of science. And we have 200 million data points that prove just how badly it works at keeping Americans slender.
I'm thus pretty skeptical that we're going to do much about obesity through the sort of mild nudges that a lot of the discussion about changing peoples' eating habits implicitly imagines. For example, I'm a big fan of Brian Wansink's Mindless Eating, which details all the ways that we take in more calories than we think. But I'm skeptical that in the long run, these factors make all that much difference. If you think about it, taking in an extra fifty calories a day more than you need--half a piece of bread, or a few cocktail nuts--is enough to pack on an extra five pounds a year. If we really at that mindlessly all the time, we'd all be morbidly obese. I expect that in any given sitting, things like portion size, or calorie counts, can cause people to reduce their intake. But over time, I doubt they'll have much impact.
That leaves more illiberal options, like forcing manufacturers to change their foods in order to make them less apealling, or massive taxes on fat, sugar, and salt. Even if I thought there was a practical, and politically acceptable, way to carry this out, I'd be against it. Enacting national health care, and then declaring that it now gives you the right to dictate how people will eat . . . well, that's exactly the sort of thing libertarians are talking about when they bemoan the creepign nanny state.
And yet papers trickle out that show that the overweight - and even the not-too-obese - outlive the skinny and the "normal". Perhaps that's why life expectancy is still increasing, to the ruination of the survivng pension schemes. As for knee joints - pad the sidewalks.
I'm all for a fat tax. As long as the vending machine has a built-in scale so that my 132lb self doesn't have to pay the fat tax, I'm all for it.
It seriously chaps my hide that I can't get any kind of salad dressing but fat-free when I eat out at some restaurants. All because of the poor choices made by some others.
CosmicLint, I feel the same way about whole milk. Everywhere you go, it's two percent or skim.
For some reason, it especially annoys me when my small children can't get anything but diet milk while we're out. Oh, everybody has sugar-laden chocolate milk and/or nutritionally worthless apple juice out the wazoo. I can order my kids soda of course. But plain whole milk? Can't have that. That would have FAT in it.
On the other hand, with the average hourly work week hitting record lows (around 33 hours), the 40+ hour work week that led many to fast food diets may be coming to an end. With less available work, more time to cook.
So, Obama's destruction of our economy may in fact make us more healthy and lower health costs.
And this is why it's important to take on big AG.
If you're really rich, and you don't want to pay for the health care of all those out-of-work journalists, time to lobby for a sane agriculture policy.
Tax income at a rate equal to peoples body fat!
Or just keep telling everyone that it is their patriotic duty to forgo desert and exercise.
Maybe we can have a mandatory morning indoctrination sessions that include exercise... The whole thing will be much more authentic with a big red flag
Megan,
A few things that came to mind:
Taxing food to reduce obesity because it's for the public good sounds alot like taxing tabacco products to reduce consumption for the public good.
Similarly, since healthcare is quickly becoming a "right", shouldn't we either:
Punitize unhealthy living (i.e. smoking/obesity)
Incentivize healthy living (i.e. blue cross/blue shield "healthy lifestyles" rebate)
Since you've pointed out the obvious problem with punitizing, why don't we simply provide tax rebates/incentives to those who exhibit a healthy lifestyle?
The only downside I can initially think of is that you'd have a higher base tax apply to all, but that's what we're going to get no matter what...
Joe
I cry a little inside thinking of stuff like that.
1) A government office determining what is a "healthy lifestyle" - food, motorcycles, sky-diving, iron-working, exercise regmines, pregnancy, vacation - and then having the power to tax you for it.
2) Lobbyists trying to get incentives for their food/gym/classes/DVDs/activites declared "healthy" or given extra points for healthiness
3) Candidates running on lowering the "unhealthy" tax penalty
4) Having to prove to the IRS that I was in fact healthy for 60+% of the year so I can get my "healthy" tax rebate'
On the plus side, I will get to watch NOW and NARAL forget wholesale what "My body, my choice" means.
Shrug. After my doctor said my cholesterol was a bit high, I lost twenty pounds in four months through the simple expediency of eating exactly what I did before, only in smaller portions. I didn't need smaller portions in restaurants, either; I just ate half of what I ordered and then had the rest the next day.
For the first few months I was terribly hungry all the time, but eventually I got used to the smaller portions. I suppose it doesn't work for everyone, as it is unpleasant to be hungry, and the cravings to eat can grow quite tremendously. There's no particularly easy way around being hungry; your body does tend to relate hunger to calories consumed.
A few years ago, I was killing time at work and took one of those "how long will you live for" quizzes. It said I was going to die at 56. I figured I probably should start taking my health seriously.
Over a two-year period, I dropped about 100 pounds, by eating better and by exercising. I've managed to keep it off for the last few years. I still eat more than I should, but I also do 90 minutes of cardio pretty much every day. I can't say that I'm hungry all the time, and when I was at first I mostly needed to remind myself how important it was that I lose the weight so I don't die in the near future.
I've become much less sympathetic to anyone who claims that they can't lose weight, that it's entirely genetic that they are overweight, ect. Sure, genetics play a factor, but you can overcome them, if you put the effort into it.
Effort requires willpower and dedication....sustained. Too many people have heard about "cheat days" and other things.
It's the equivalent of giving up smoking ....no matter how you do it, you need to do it with a sense of purpose and unwavering dedication to your goal. Eat the brownie if you want, but pay the price later on one way or another.
If you think about it, taking in an extra fifty calories a day more than you need--half a piece of bread, or a few cocktail nuts--is enough to pack on an extra five pounds a year.
I wonder if this is really true. I have noticed that on days when I don't run--whether because of time pressures, or because my knees need a day off--I am flushed and sweaty for much of the day. Same thing happens when I heat a really monstrous meal (like at Thanksgiving, say).
So I wonder if there isn't some capacity for the body to adjust how much energy it burns off in heat in response to changes in intake/activity.
So many of us gain and lose weight at a very slow rate. Is that really because we all perfectly balance our diets with our activity, or is there some threshold in imbalance that must be exceeded before your body decides to adjust the amount of fat storage rather than simply burn more/less calories?
Rob, she's just doing the math for that - 50 cal x 365 days = 18,250 / 3500 cal/lb = 5.2
That's also the reason people like John Walker at The Hacker's Diet www.fourmilab.ch/hackdiet/ stress you can't really exercise your way to losing wait. A Big Mac near cancels out an hour of running, you have to cut calories IN because it's much harder to burn them once they're there.
Nonetheless, it's a pretty asinine comparison to be honest. Our daily needs vary widely. The comment was "more than you need"....so it's basically saying that if I continually take in more than I put out, I'll gain.
That works in business too....if I continue to bring in more revenue than I spend, I'll gain!
Blows my mind :)
Calories burned during the activity is not the end measure of calories burned since the metabolism spikes in response to sustained physical activity and then declines gradually over the course of a day or so.
Yep, the metabolic needs of repair and rebuild activities. An hour of exercise might burn 500 calories, but during that time you put an hour's worth of wear and tear on the system. It now burns lots of calories in rebuilding the torn down muscle and restoring a healthy size of sugar (glycogen) in the muscle for the next time it's needed.
I understand that an extra Big Mac can offset an hour of running*, but who actually eats an extra Big Mac on a given day with any regularity? Splurging and having a candy bar for a snack, sure, I can see that. But does anyone really say at 3:00 PM "boy, I could really go for a two-all-beef-patty snack about now!"?
* Not really. I'll do about 9 miles in an hour of training, maybe a touch more. That's over 1000 calories, so about 1.7 or so Big Macs.
Joe, it's not that you wipe it out with a snack Big Mac on a regular basis. My point is that when people who eat poorly start to try to lose wait by simply exercising - they simply can't do it on average. They run for 30 min, lift or take a class a few times a week, but *reward* themselves with a desert or second cheeseburger or donuts - and there goes there caloric deficit.
You need to reduce your caloric intake, but not radically. Most people in their late twenties or thirties, if they simply stick to 1800-2000 calories a day can lose weight even with only moderate exercise.
People running 7 minute miles as a regular part of their weekly routine are not the people who need to think about this.
Skullberg-
A Big Mac near cancels out an hour of running, you have to cut calories IN because it's much harder to burn them once they're there.
I'm reminded of the Heinlein short, "Cliff and the Calories".
He roared. "Honey child," he said, "do you know how far you would have to hike to burn up one chocolate malt? Eight miles! It will help, but not much."
As I understand, the reason we're all just plain old obese (and not morbidly obese) from eating "just a little extra" is that increased mass somewhat increases your daily usage of calories. So the situation is self-stabilizing.
1 pound of fat will burn about 1-2 calories a day to sustain itself.
The argument comes moreso in the extra effort needed to carry around and function with an extra 10-20 pounds hanging off of you, but that's self-regulating as well in that many people get lazier to avoid the extra effort.
FYI, and I've watched, my mother (obese) consumes about 1200-1500 calories a day and remains obese. It's because she does so little physical activity that her body has almost no muscle mass left, so it's just cruising along with an extra 70-80 pounds of fat on far less calories than I consume with a body fat of around 10%.
John - that's great that you were able to do that.
Rob - Your metabolism adapts to what you eat, when you eat, how much you eat, how much exercise you get, how much sleep you get, etc... For example, if you skip breakfast, your metabolism will slow down and you'll gain more weight (presumably your body goes into a "food is scarce" mode). So when you go on your diet, allow for some of your calories to be eaten at breakfast time. Also, a calorie is not a calorie is not a calorie. Calories on food labels are calculated by a formula where carbs and protein are 4 calories per gram and fat is 9 calories per gram. Well... those are estimates that vary from food to food and your body doesn't process all carbs, proteins, or fats the same way.
I'm hoping they figure out what it is that allows some people to eat all they want while remaining at a healthy weight and then make a pill for it. That is probably the only way large numbers of people will be able to lose and sustain the loss of significant weight. Either that or let Obama finish destroying the economy so we all go back to a hunter-gatherer lifestyle.
Earnest - I'm going to pick a bone here. Your "metabolism" statement is more accurately described as "your hormones"....and yes, they are different. Skipping breakfast will have a hormonal response that tells your body to hoard fat, sleep deprivation can stimulate many of the same hormones. But hormonal regulation is different from metabolism, in that almost none of the above scenarios will change the metabolic requirements of inhaling and exhaling, pumping your heart, blinking your eyes, heating your body mass to ~25 degrees above ambient temperature, etc.
Those things, along with digestive activities and physical activities are metabolism and don't change much with sleep deprivation or skipping a meal.
This isn't just a bone to pick , it seems to be a reasonable attack on something I've heard a million times that sounds insane.
How on earth could it be possible that 'metabolism' could 'slow down' without a significant impact on your physical and mental well-being. This 'metabolism' slowing argument assumes that our bodies can magically adjust itself without any ill-effects -- it never made any sense to me.
Any answers? I can certainly understand how one's metabolism might 'slow' and suddenly one could barely move, but if you expend the same amount of calories breathing,living,moving etc -- than how can a 'slow' metabolism accomplish that magic trick? I could imagine a slight change in the amount of heat you give off with a different metabolism -- but that can be that much can it?
You pretty much hit the nail on the head. It's the equivalent of any system, but I'll use an automobile here.
Point A to Point B takes 1000 miles. One day you are driving aggressively, you use more fuel. Another day you drive conservatively, you use less. One day the air is cool and humid, you use less, another day it's hot and humid and you use more fuel. But at the end of all these days, the car still needed to use a pretty consistent level of fuel to get from point A to point B.
Our bodies basal metabolic rate is about 70% of our overall metabolism. This is stuff like breathing, pumping blood, brain function, liver function, cellular regeneration and transport, etc.
Another 10% is digestion of food. The act of chewing, salivating, digesting in the stomach, pumping through the intestines, and ultimately excreting.
The other ~20% is your physical activity. Basically what I'm saying is that to live and eat, 1600 calories of a 2000 calorie diet are used no matter if you stay in bed or not. The other 400 are going to be used in daily tasks.
Now let's say you had a "thyroid problem". It doesn't suddenly take 30% less energy to power your brain, pump your blood, etc. So as long as you are functioning in a base normal manner, you are expending 70% and hopefully digesting another 10% of all calories your body uses.
Similarly, hormonal changes within normal limits won't change this too much. A massive change in a hormone can do certain things but, again, your body is still going to take a certain amount of energy to perform a certain amount of work.
This is fairly basic stuff, but it gets fought constantly.
Joe
P.s I'm dealing with the basic concept of body function, so please don't expand my meaning beyond what I'm saying.
How on earth could it be possible that 'metabolism' could 'slow down' without a significant impact on your physical and mental well-being.
Who said that it does not present a significant impact on one's physical and mental health?
Try eating 5-6 times a day with smaller portions. You will see how much more energy you have during your day with an equivalent amount of energy intake.
Steve, let me throw this anecdote out for you.
Last year over about 6 months I lost 40 lbs (25 percent of my body weight) with about the same technique as John Thacker upthread: flat out portion control. Got smaller plates à la Mindless Eating (divided 8-1/2 inch "luncheon" plates put out by Corelle) and made sure half my plate was vegetables for every lunch and dinner. When I ate out I followed a rule of thumb: "Enough salad for two people, enough other stuff for half a person." I counted calories a few times, but I can tell you that I probably ate twice as much food before as after.
The thing I noticed when I was losing weight? I felt cold. ALL THE TIME. I wore a hat to bed. This had never happened to me before.
I really believe that when I was heavy and stable (my weight didn't change for 15 years except for pregnancies), my body was able to throw off a lot of excess calories in heat and thereby maintain my (high) weight even though some days, yes, I would eat an entire pizza.
I really don't understand the libertarian objection to progress.
Look, here's how it works:
1) For the good of society (and you, to the extent that you are a part of society), your betters take over the provision and determination of your health-care options.
2) To aid them in step one they take over your diet and excercise options.
Isn't this the whole point of government? To give those of us who are simply better people than the rest the power they need to force all of us up to their standard of living?
How can someone go on and on all day about loss of "freedom" when the net result of all of this will be you living a better, healthier, longer, more productive life? Are we really going to listen to those who for some archaic and psychologically-suspect reason refuse to be forced into living a more productive, socially-esponsible, environmentally-sustainable & all around purer & more just lifestyle?
Here's the bottom line: if we promise to organize your life in such a way that you end up happier, healthier, more well-rounded (not in a physical way though! Ha ha!) and accomplishing more with your alloted resources than you could have ever hoped for if given your own 'freedom' to decide what to eat, when to excercise, when to go to the doctor, what to work at, etc., etc. then why would you complain?
This is what the coming glorious utopia that Obama is ushering in will mean. A better life for everyone, whether they want it or not.
Was that comment sarcastic or serious? I can't tell.
Rob, she's just doing the math for that - 50 cal x 365 days = 18,250 / 3500 cal/lb = 5.2
Right, and my point is, does the body really work that way? I don't know, but it seems to me that my body doesn't, because it seems as though it burns off extra calories (at least some amount of extra calories) as heat. That is to say, "need" seems as though it might be pretty elastic, so that you might not be able to lose weight by dropping a half-slice of bread a day.
Rob - She literally said that if you consume 50 calories more than you expend, over the course of a year you'll gain 5 pounds. It's technically correct, but kinda pointless at the same time (no offense Megan) as it's true of any storage mechanism....you take in more than you expend and you'll wind up with more in storage :)
Joe
Joe,
I think in fairness, Megan's point is to quantify the relationship. Or, more accurately, to do the basic unit analysis for the reader. You may be used to casually translating kcal/day to body mass/yr, but most people aren't. As such I don't think it was entirely useless.
Yes, the divergence theorem applied to everyday life. Maybe SoV can do us a proof, it's been so long that I forgot how.
We tax the wrong things
let's heavily tax
gasoline
carry-out food (all)
alcohol
cigarettes, cigars, snuff
tires
apparel
then let's lower taxes on returns on savings and investment and earned income (especially for upper income people who bear a ridiculous tax burden)
If we could tax fat people I'd be all for it, but we should definately charge them more for airline tickets, etc. (Anybody see where Delta Airlines flight attendants were up on arms - as afar as they could lift them - because the airline's "signature" red dress only went up to size 18? Not size 24! They used to fire plump flight attendants and should go back to that!)
Josez - That's called a consumption tax system, and it's been proposed in place of income tax.....if it's actually put in place as a replacement, I totally support as an effect on the entire system, and not just the items you named.
Consumption taxes (in place of income taxes AND highly taxed items) are vastly more progressive. Those who consume more of any item pay more taxes, those who choose to limit their consumption are rewarded with a lower tax burden for their frugality.
Megan:
One of the big problems here is that eating "right" is both rocket science, and *heavily* politicized.
There is quite a bit of evidence that grains like wheat and rye are "bad" for you. There is quite a bit of evidence that red meat is good, even in in larger quantities. I'm not just talking about that silly fad diet...Uh...can't remember the name.
The estimates I've seen suggest that even careful calorie counting will still have an error of at least 5% (100 calories on a 2000 calorie diet for those in Reo Linda . This makes 50 extra calories a day "noise" in the statistics. If your feedback loops (no pun intended) were working right you'd just not bother to eat every bit of chicken off the bone, or sop all the gravy up with the bread.
Of course there's also a bit if evidence that artifical sweeteners and other industrial processing of food screws up these feedback mechanisms.
Another factor no one takes into account is how much of our eating problem is based on low quality food? If you eat a small *tasty* meal it is supposed to satisfy more than a large rather bland meal.
Then again when you're used to 12 ounce steaks, that four ounces of Kobi beef feels more like a snack.
Of course the Legislative Culture wants to use Congress to solve these problems without ever looking to see how much of the problem Congress caused with legislation (price supports on Sugar and other crops etc.).
@FFS:
"overweight" is IIRC 20-30 percent body fat. I'm inside this range, and I have (well, most of the time) a resting heart rate in the upper 50s to low 60s from working out 3 to 10 hours a week (depending on whim, season, and your definition of "working out"). But I'm in my 40s.
I also strongly suspect that this is for people who attain or retain that level into their 60s and 70s, not people who are that way in their 20s and 30s and put on the roughly 1-2 pounds a year that seem normal in our culture.
Last I checked, excessively tall people - like our hostess - also use a disproportionate amount of health care. Joint issues, circulatory problems, etc.
We going to "intercede" there, too? Perhaps some hormone therapy during puberty?
What about kids with Type 1 Diabetes? Unlike many cancers, there's really no cure for that. Type 1 Diabetes is basically a guarantee of an ongoing drain on the health care system.
Who's up for euthanizing these kids?
What about driving motorcycles? Unlike height and chronic diseases, this is 100% a lifestyle choice.
Who's in for making "donorcycles" a thing of the past?
And, voila, I believe I've finally found the back-door to effective gun control AND stopping all blood sports.
Guns? Accidents and/or fatalities waiting to happen. They're illegal. Ditto Boxing and Martial Arts - they cause far too many injuries relative to the cardio-benefits.
If we take a actuaries view of things: Bicycles probably fall into the "too dangerous, relative to benefit received" category, too. There are certainly less hazardous ways of staying in shape. The incidence of traumatic head injuries, alone, makes bicycling a foolish activity for society to accept, when the whole nation has to bear the treatment costs.
Stick to Walking and Yoga. Everybody.
Or else.
Pissing in a lake or stream contaminates it in some real sense but I don't see arguments against the regulation of dumping of toxic wastes into lakes or streams plagued by these sorts of objections.
If you think about it, taking in an extra fifty calories a day more than you need--half a piece of bread, or a few cocktail nuts--is enough to pack on an extra five pounds a year. If we really at that mindlessly all the time, we'd all be morbidly obese. I expect that in any given sitting, things like portion size, or calorie counts, can cause people to reduce their intake. But over time, I doubt they'll have much impact.
This is EXACTLY right. I have seen so many people talk and study the obesity problem without doing basic estimates like that.
The other over the top prediction is that if our bodies weren't regulating the calories that we took in then we could easily accidentally burn off enough calories starve to death just by playing pick-up basketball everyday.
I responded to Ezra's first post on the subject with a discussion of the different theories of obesity and why in the end we don't exactly know why people get fat, here:
http://modeledbehavior.com/2009/07/10/the-limits-of-technocracy/
It seems to have something to do with the composition of the food they eat. It doesn't seem to have anything directly to do with physical exercise.
I frequently see pubescent-aged children now that look nothing so much as a pig ready for slaughter. And I've seen more then a few pigs in my life. I speak pig fluently.
My children are in their early 20's, and that look was not nearly as common then as now. Something very fundamental in our national diet changed.
(Apologies to Ken M. for the personal observation.)
I'm not sure it's our diet so much as our lifestyle - far less out-door playing and exercise in schools activities - compounded by 'easy' parents.
Diet has probably gotten worse (see the latter above) but really that's a failure of parenting, not something that needs a national solution.
The problems in the food bill that contribute to our health-care costs might be worth considering.
The problem with the lifestyle hypothesis is two fold
1)Exercise as an intervention is doesn't seem to be that effective. When participants in a study environment increase exercise they do loose weight on average but not much and some gain weight
When we compare controlled diet with exercise to controlled diet without exercise their is no difference. My theory is that in a diet uncontrolled environment the exercisers will unconsciously diet.
2)Calorie expenditure and food intake are linearly matched in all but the most sedentary people. These people tend to be very overweight but you do not know if they are overweight because they are highly sedentary or sedentary because they are really overweight.
Instead of these illiberal or otherwise ineffective options, perhaps the government can embark on a massive and much-needed public service ad campaign to convince people that others would consider them more sexually attractive if they were thinner.
As someone who worked directly with overweight and obese patients in a clinical setting, I have often thought that a variant of your idea would work very well. (I once cared for a 450 pound female patient in her 20's. It was heartbreaking. Imagine how restricted your life would be in that condition.)
But I'd cross out the "sexually attractive" aspect, as it's somewhat beside the point. (Although perhaps not in this hyper-sexualized society.)
We used to have physical education in the public schools. They were crappy programs, but they were still there. Now, most schools don't even have the funds for that.
We need a full-scale government intervention in the public schools at every grade level - kids will have to learn to run (if they're heavy, they can work up to running through walking), do calisthenics, basic yoga stretches to avoid wear and tear on joints, and nutrition classes.
That intensive P.E. program, combined with a media campaign, could do wonders. Active kids are also less likely to drop out of school or do drugs.
A Phys Ed program that not only maintains the health of fit kids, but thoughtfully and welcomingly reaches out to kids who are at risk for overweight/obesity would be great.
From a public health perspective, I also think we need to get away from the notion of "shaming" overweight people, and be more inviting to overweight people to get active. A fat and active patient is almost always healthier than a fat, inactive patient.
And, uh, the food industry? That needs to be addressed.
Dr. David Kessler (former FDA head) has a good book on how the food industry has changed the neural pathways of Americans - and in turn helped make them more fat. It's called "The End of Overeating." It's actually a quite sobering read.
I'm going to hope you're both joking, and don't actually think that fat people don't know that they're not considered sexually attractive. Trust me, we know. We're told every damned day.
Up to a few years ago in Illinois, every school child K-12 had physical education every day.
Are Illinois kids healthier than comparable peers in other states?
I believe that on the massive U.S. obesity map, Illinois is in the middle (if you remove the outlier of Colorado), but this map is from 2009. Covers adults, so ostensibly wouldn't be affected by the cuts you're discussing.
http://www.msnbc.msn.com/id/31672178/ns/health-diet_and_nutrition
Also note that these rates are statewide. I've seen other maps that show significant disparities within states - e.g., urban California fares better than inland California.
Which makes me wonder what percentage of the residents they're measuring, if urban CA is marked as less obese than inland. I have yet to see an obese Latino farm worker, and while they might not be legal, they still constitute part of the population.
There's been a fair amount of discussion of illegal immigrants' use of the health care system in California, but for two of the most costly diseases - Type II Diabetes and heart disease - illegal immigrants who work in the fields would ostensibly not be lining up for those services. (Any physical activity primes the cells to make insulin, and most farm workers are sticking to a more traditional, high-fiber diet - beans, rice and tortillas. We see higher rates of T2 and heart disease in Asians and Latinos who 1) are physically inactive and 2) adopt a Westernized diet, which includes higher levels of fat, animal protein, and refined carbs.)
Too much ambiguity. A stronger plan would be for (attractive) health service employees to offer to sleep with the targets every other day for a month if they lose the appropriate weight.
Years ago, I found myself about 40 pounds overweight. Then I got a job at a tennis center where I stood at the counter and walked around the courts twice a shift. Living a more mobile life, I walked a lot more in general - I was used to it. I got back to about five pounds overweight (per my doctor).
Now I work in an office. I'm paid to sit in a chair, answer the phone, greet clients and do accounting on the computer. And I'm twenty pounds overweight. Is this a surprise? Let's face it: I'm being paid to live a sedentary lifestyle eight hours a day - my presence at the desk and by the phone are two big requirements for fulfilling my job functions. And guess what! - my energy level when I get home doesn't exactly leave me raring to jump on the exercycle. I've started walking a half-hour at lunch and standing and stretching more often, and it helps. Still, there's a big difference between staying active in spite of your work and staying active because of your work.
Related: When I was a kid, I rode everywhere on my bicycle. I played at the nearby creek. I climbed trees and played sandlot baseball. Today, it seems like for fear that someone might get hurt or molested, the kids are spending more and more of their time inside with Nintendo or going to lessons. Even if they're in soccer, they're riding to and from practice in mom's minivan and coming home when the scheduled practice is over - a far cry from hopping on your bike at 3 o'clock and tearing around till dinner at 6:30 or 7:00.
For most of my lifetime, we've been moving from a manufacturing economy to a service economy to a knowledge economy. (This comes after moving from an economy where agriculture was still a big component.) In short, we've taken people who used to walk around, then stand around and now they're sitting. At the same time, we've taken rambunctious kids and replaced terrorizing the neighborhood with taking Ritalin and playing video games.
Of course we're not in great shape.
I think there's a lot to this. My great grandfather, who owned a farm before the so-called "green revolution", couldn't have been obese if he tried. From sunup to sundown he was doing something physical. He ate, by today's standards, prodigious amounts of calories and was as thin as a rail.
Karl Smith thinks the standard math converting calories to pounds is absurd.
Illiberal policies are just around the corner when it comes to what you are allowed to eat. You can count on it.
"Enacting national health care, and then declaring that it now gives you the right to dictate how people will eat..."
Ezra Klein's WaPo column has been doing precisely this.
A few decades ago Americans managed to avoid today's obesity rates. If we could do it 40 years ago, why can't we do it now? Today, many developed countries have substantially lower obesity rates than the US. If they can do it, why can't we? To me it is kind of bizarre to act like a relatively recent phenomena that afflicts only portion of the world's citizens is somehow an unstoppable force of nature.
Andy from Tucson,
You couldn't be more right.
I lived in France for a year. No overweight/obese people in my neighborhood.
And everyone ate wonderful, rich foods. Lots of carbs, lots of fat. There was no interest in a "skim latte" - just "cafe creme."
But they had a 35-hour work week, and they didn't eat constantly, like we Americans tend to do.
They had preposterously long lunches. No one wolfed a sandwich at their desk, guzzling diet coke in between gulps. Sometimes they sat at lunch with a bottle of wine and a pizza (yes, the French enjoy pizza, too) and watched the municipal workers march by, who were on strike. Everyone felt sympathy for the striking workers. No one said they were acting against the free market.
In fact, no one I knew in France had a strong belief in the sanctity or perfection of the free market. But all the women could fit into their clothes without the need for "10% lycra stretch" in the fabric's composition. Makes ya wonder...
Maybe there ought to be some sort of annual co-pay for insurance coverage based on lifestyle choices. Perhaps evaluated during an annual checkup. It bugs me that I am going to be paying for coverage for smokers, drinkers, the morbidly obese, etc.... - stuff that people CAN do something about. If I am going to pay for it, they owe me some basic responsibility in return.
And we'll all lie our asses off about how "healthy" we are...
Why is the surcharge going to be more effective than the huge social impact of being fat (especially when you're dating), or the huge health impact? How much are you going to charge me to give me more incentive to lose weight than my cardiologist can by having a conversation with me about why I need to lose weight? (I especially liked the part where he patted my beer belly and said "this is the thing that will kill you.")
There's something fundamentally shitty about levying extra taxes or charges or whatever on people for stuff they actually want to change, but find difficult to change. Particularly when it's also something with a lot of other costs, like smoking or being fat. It's all the moralizing fun of sin taxes, but with the advantage that the people being taxed have a hard time getting away from the sin.
But you are all accepting, completely uncritically, the popular dogma on being fat. What if it is wrong?
From the Junkfoodscience blog:-
"Their results were published in the Journal of Gerontology A Biological Sciences and Medical Sciences.
Findings. Among 981 healthy older men, 208 died during 6.9 years of follow-up. Compared to the reference ideal of a “healthy” BMI (20-24.9), men who were overweight were associated with a 34% lower risk for all-cause mortality, while the obese men (regardless of the degree of obesity) were associated with a 44% lower risk. In contrast, men with BMIs under 20 had more than a two-fold higher risk for premature death. When cardiovascular fitness was controlled for (as measured by MET = 3.5 mL/kg/min oxygen uptake on exercise tests), the slim men with BMIs below 20 were associated with an even higher 2.5 fold higher risk for premature death. Meanwhile, the most obese men had the lowest risk for all-cause mortality of all, at less than half (HR= 0.44) the “normal” weight men."
FFS -
Here's the actual stats of one analysis on BMI vs. Life expectancy:
Being overweight at age 40 reduces life expectancy by 3.3 years among men and 3.1 years among women vs. those who are considered normal weight.
Being obese at age 40 reduces life expectancy by 7.1 years among women and 5.8 years among men vs. those who are considered normal weight.
In both cases, this is for non-smokers. Smokers do worse.
Normal is considered a BMI of 20-24.9, overweight is 25-29.9, and obese is 30+.
This is a broad generalization, and BMI is not a perfect indicator, but it is a good indicator when applied to a broad strata.
Here's a JAMA article on this: http://jama.ama-assn.org/cgi/content/full/289/2/187
Their conclusion: "Conclusion Obesity appears to lessen life expectancy markedly, especially among younger adults. "
The waters are murky between 25-30 BMI (overweight) and I tend to agree that that area of the BMI progression is the most useless to apply to the population.
Those under 20 BMI (underweight) tend to have lower life expectancy, but it appears to be because there are alot of sub-20 BMI smokers.
Hope this data helps you.
BMI sux FTW!!!!one!!!!
Thanks. But then:-
http://junkfoodscience.blogspot.com/2009/06/paradoxes-compel-us-to-think-part-two.html
Other factors to be aware of:
1. losing weight and gaining is back is worse for your health than never losing at all
2. an overwhelming majority who lose weight gain it back, and many put on more than they lost originally
So ... heavy-handed "encouragement" could end up not only being the libertarian nightmare, but could be just plain counterproductive. This could lead to a cycle of increasing heavy-handedness to force people to do the hardest thing, which is to keep it off.
BTW, smoking is a bad analogy -- smoking is unnecessary, and small amounts are bad for you. Food is something we have to have, and even "bad food" is not a bad thing per se within a totality. Add to that the metabolic differences that people naturally have.
So for smoking to be a good analogy, imagine that everyone needed to smoke to live, but needed between 5-10 smokes a day to survive depending on their make-up.
I was going to make the same point about the smoking analogy but you beat me to it. I'll go further: taxing tobacco for public health makes much more sense than taxing fat because of the very high probability that smoking will harm an individual's health. The link is about as clear as it gets.
Taxing fat for the same reason doesn't provide us with anywhere near as clear of a link between consumption and health. If I'm overweight and consume, say, 100 g of fat a day, and you do the same but keep a healthy weight, why in the world should *you* be paying the fat tax?
Assuming that the legion of fat bureaucrats and politicians (Ted Kennedy, Sotomayor, etc.) and their paid scientists know the secret to weight loss and healthy eating is illustrative of the government's ineptitude. The Food Pyramid and BMI have been shown to be almost useless, yet that is the standard dogma throughout government offices.
We need to stop assuming the state has any knowledge that we don't have. At best, they have imperfect knowledge and work off of soon-to-be outdated theoretical models, but the bureaucrats and vested interests won't change as quickly. Worse yet, they have almost unfettered power to dictate policy based on this shoddy information.
Allowing the state to force us to buy medical care and dictate our food choices is insane. What ever happened to personal responsibility?
I'm also skeptical that calories in - calories out = change in weight
Read Taubes' Good Calories, Bad Calories.
The government owns whatever it subsidizes. If it subsidizes your body it owns. It's that simple.
I am actually tiered of saying this - but an end of fat and sugar subsides is something that libertarians, conservatives and liberals should be able to live with. Why does it not happen? Doing so would make healthy foods economically more attractive.
Most voters claim that they are against factory farms on ethical and environmental grounds and yet they support them daily. Is prohibiting something on ethical grounds alone anti-libertarians. I hope not. Doing so would make healthy foods economically more attractive. Why does this not happen?
Why are we not using market-forces?
Because those who apparently believe in the market do not take subjects such as food, health and the environment very seriously. Many only react when the liberals, who do take these subjects seriously, come along and want to implement statists solutions. It only then that many raise their voices. Many on the right critique how inefficient statist suggestions are - they might mention some better market alternatives - but they never really fight for the subjects at hand. Libertarians and conservatives come across as if arguing ideologically against suggested solution to important problems is more important than the problems at hand. It comes across as false. It is.
In other words - it is a pity that so many libertarians and conservatives are inactive when it comes to agriculture, food and health. Then again - you can't find a market solution to a problem if you don't accept or perceive or ignore that there is a problem. If you really cared about the real problems at hand - it is time to act. Get rid of farm subsidies to the rich and get rid of factory farms. Or shut up and watch the statists take over. I would not be happy to see it - but I would know why it happens. Time to act or to shut up.
Hugo - The problem with your idea of "ending sugar subsidies", is that at least for sugar the government doesn't make it less expensive, the government makes it more expensive. The primary intervention is not direct subsidies but restrictions in imports. If the government got out of the way sugar would be much cheaper (OTOH other things we might want people to eat less of would probably be more expensive).
As for "factory farming", well we can move away from it for premium products, and we can reduce the subsidies for it to chip away at it on the margin, but its going to be the primary way we produce many types of agricultural goods for the foreseeable future. We might move from 1% farmed organic, by hand, farming (just a number pulled out of thin air, I don't know the actual percentage), to maybe 10%, 50% or 100% is a very impractical goal. Partially because of the dollar cost, and also because of the extra farm workers, and perhaps extra land that you would need.
Hugo - the problem is that the farm subsidies go to people who give a lot of money to politicians and therefore have relatively loud voices. The rest of us who want to end farm subsidies do not have the funds to spend on getting our voices heard. I suspect that politicians have found that stopping the giving of money to one group pisses them off a lot more than the giving pisses off everyone else. So while I would love to see an end to farm subsidis I am not very hopeful.
Yes - and many farmers are part of e.g. the GOP and vice versa. The party that claims to embrace the market cannot due to... what? The GOP is bigger than the farm lobby. They could afford to lose the vote of farmers as it is a tiny percentage. The flood of new voters would also bring in more money to compensate for the loses from the lobby industry etc.
The GOP cannot take on any ideological battle as long as it does not clean up their own statist farming mess - which is worse than "The Unions". The GOP cannot take on any ideological battles for the mere sake of it - when everybody knows that they are only talk, reaction and no action - nobody will care.
They have not learned a thing from Obama's election. They still come across as right vs left and not as health vs obesity. Right now their activism consists of claiming that a summa cum laude from Harvard does not count much? Good luck with that.
Hugo,
How much of the GOP in Montana is related to the Farm / Ranch economy there? How much of the Democratic party? Is it possible to become a Senator or Representative from Montana (or Iowa) by telling a large portion of the state that you are taking away money from them because people in New England or New Mexico don't like it.
Skullberg - Margaret Thatcher got elected twice on that slogan. If your voters believe in conservatism and markets - I sure hope that they can be sold on it? If they don't believe in conservatism and markets - then they should shut up when Uncle Nanny shows up. No? Some of these states refused stimulus money from Obama but they need statist money to survive? What a joke this conservative movement has become?
If you could credibly run on cutting their taxes by the same amount of the subsidies - I think they would buy that. In reality you'd have to run on taking food from their table to spend it on increase social welfare programs, defense, etc.. In that math, they're worse off without the subsidy.
About 5 percent of the population has trouble using insulin effectively because they can't make d-chiro inositol. The stuff looks like it could be helpful for PCOS symptoms and maybe even weight loss for those with PCOS in their family.
That leaves more illiberal options, like forcing manufacturers to change their foods in order to make them less apealling, or massive taxes on fat, sugar, and salt.
With all due respect, coercive government activity to make a more perfect human according to their standards is in fact the most "Liberal" part of their MO. It is the heart of all collectivist authoritarian doctrine that mankind is perfectable with the right coercion.
You notice which party is in control of the government and which is about to impose just those very types of societal coercion.
Subotai Bahadur
Enacting national health care, and then declaring that it now gives you the right to dictate how people will eat . . . well, that's exactly the sort of thing libertarians are talking about when they bemoan the creepign nanny state.
I'm a libertarian, but I'm not opposed to national healthcare. If you want my support on it, however, you better be willing to tax the bejeezus out of fat, cholesterol, and any other dietary substances which contribute to lifelong health problems, not to mention tobacco, alcohol, and (legalized) drugs. I've got no truck with someone else ruining their own body if they so choose, but as a non-smoking, light-drinking, non-drug using, non-junkfood consuming regular exerciser I shouldn't have to subsidize their bad habits.
The typos in this post are ridiculous. You blog for the Atlantic! Can't you at least spell check??